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Complex Indirect Carotid-Cavernous Fistula With Contralateral Ophthalmic Manifestations.

Amirah Mohammad Razali1, Mohammad Jazli Sobri2, Muhammad Khairul Adha Fuad2

  • 1Ophthalmology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS.

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|December 16, 2024
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Summary

A rare case of indirect carotid-cavernous fistula (CCF) presented with contralateral symptoms. Despite unsuccessful endovascular embolization, the patient experienced a stroke with favorable functional recovery.

Keywords:
carotid-cavernous sinus fistulacorkscrew vesselsdiplopiaendovascular embolizationproptosis

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Area of Science:

  • Vascular Neurology
  • Interventional Neuroradiology
  • Ophthalmology

Background:

  • Carotid-cavernous fistula (CCF) is an abnormal connection between the carotid artery and cavernous sinus.
  • Indirect CCF typically affects post-menopausal women, with contralateral symptoms being uncommon.

Observation:

  • A 79-year-old female with hypertension and dyslipidemia presented with a complex indirect CCF.
  • The fistula involved the right internal and external carotid arteries, draining into the left ophthalmic vein.
  • This resulted in left-sided ocular manifestations.

Findings:

  • Endovascular embolization was attempted but ultimately unsuccessful in treating the CCF.
  • The patient suffered a stroke one day after the procedure.
  • Despite the stroke, she demonstrated a favorable recovery of neurological function.

Implications:

  • This case highlights the unusual presentation of indirect CCF with contralateral symptoms.
  • It underscores the potential complications, such as stroke, associated with endovascular treatment attempts.
  • The favorable outcome emphasizes the possibility of recovery even after procedural complications.